Pretreatment 18F-FDG PET/CT combined with quantification of clonal circulating plasma cells as a potential risk model in patients with newly diagnosed multiple myeloma

  • Yoshiaki AbeEmail author
  • Kentaro Narita
  • Hiroki Kobayashi
  • Akihiro Kitadate
  • Daisuke Miura
  • Masami Takeuchi
  • Eri O’uchi
  • Toshihiro O’uchi
  • Kosei Matsue
Original Article



Both 18F-FDG PET/CT and clonal circulating plasma cell (CPC) quantification are emerging tools for multiple myeloma (MM) prognostication that have been validated in recent studies. This study investigated the value of PET/CT coupled with CPC quantification for MM prognostication that may contribute to future risk-adapted treatment.


We retrospectively analysed the prognostic relevance of a combination of pretreatment PET/CT findings and CPC levels in 163 consecutive patients with newly diagnosed, symptomatic MM receiving novel agents during induction therapies.


High-risk PET/CT findings and elevated CPC levels were defined by the presence of >3 focal lesions with or without extramedullary disease and CPCs ≥0.10% of the total mononuclear cells evaluated, respectively. Subsequently, patients were divided into three groups: PET-CPC stage I included patients with no high-risk PET/CT findings and low CPC levels; stage III included patients with high-risk PET/CT findings and high CPC levels; and stage II included the remaining patients. The three groups of patients differed significantly in terms of both progression-free survival (PFS) and overall survival (OS) (median PFS: not reached [NR] and 36.4 and 15.9 months, and median OS: NR, NR, and 40.4 months for stages I, II, and III, respectively; P < 0.001 for both PFS and OS). This system discriminated both PFS and OS even among younger (age < 75 years) or older (≥ 75 years) patients, patients with Revised International Staging System stage II or III, and patients with or without high-risk cytogenetic characteristics. In the multivariate analysis, the PET-CPC staging system remained prognostic for both PFS and OS.


The PET-CPC staging system predicted survival outcomes independently of established risk factors in patients with newly diagnosed MM. Pretreatment 18F-FDG PET/CT assessment combined with CPC quantification may improve the prognostication of MM and facilitate the development of novel risk-adapted approaches for MM.


Circulating plasma cell Focal lesion Multiple myeloma Positron emission tomography/computed tomography Prognosis 



The authors would like to thank the staff of the Department of Radiology, Kameda Medical Centre, Kamogawa, Japan, for their help in making this study possible. We also thank Editage ( for English language editing.

Author contributions

YA conceived, designed, and initiated the study, collected data, performed all statistical analyses, wrote the manuscript, and provided patient care. KN, HK, AK, DM, and MT provided patient care. EO and TO interpreted the PET/CT images. KM supervised the study and provided patient care. All authors reviewed and approved the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

259_2019_4275_MOESM1_ESM.pdf (322 kb)
Fig. S1 Survival according to the presence or absence of more than three focal lesions (FLs) (high-risk PET/CT findings). (A) Progression-free survival and (B) overall survival in patients with and without high-risk PET/CT findings. Fig. S2 Survival according to the levels of maximum standardised uptake value (SUVmax). (A) Progression-free survival and (B) overall survival in patients with lower (< 4.2) and higher (≥ 4.2) SUVmax. Fig. S3 Survival according to the presence or absence of extramedullary diseases (EMDs). (A) Progression-free survival and (B) overall survival in patients with and without EMDs. Fig. S4 Receiver operating characteristic (ROC) curve analysis. ROC curve analysis for circulating plasma cells (CPCs) predicting the highest risk of disease progression within 2 years (A) or death within 5 years (B). Fig. S5 Survival according to the levels of clonal circulating plasma cells (CPCs). (A) Progression-free survival and (B) overall survival in patients with lower (<0.10%) and higher (≥0.10%) CPC levels. Fig. S6 Progression-free survival (PFS) according to the PET-circulating plasma cell (PET-CPC) staging system in patients with different ages. PFS according to the PET-CPC staging system in (A) younger (age < 75 years) and (B) older (≥75 years) patients. Fig. S7 Progression-free survival (PFS) according to the PET-circulating plasma cell (PET-CPC) staging system in patients with different Revised International Staging System (R-ISS) stages. PFS according to the PET-CPC staging system in patients with (A) R-ISS stage II and (B) R-ISS stage III. (PDF 322 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Haematology/Oncology, Department of Internal MedicineKameda Medical CentreKamogawaJapan
  2. 2.Department of RadiologyKameda Medical CentreKamogawaJapan

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